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Debate Between Individual and Public Rights

© Ian Chovil

One of the most hotly debated issues in the treatment of schizophrenia is "how do you treat someone who doesn't know they are ill without denying them their civil rights"? The law per se has very little awareness of the dynamics of an illness like schizophrenia. There are too many examples in world history of the abuse of power, so lawyers champion civil rights as one of the sacred principles of a civilized country. In the Soviet Union, political dissidents were hauled off to psychiatric hospitals for re-education, never to be seen again. Hitler's Nazism will frighten legislators for generations to come. During World War Two many people with schizophrenia were executed in concentration camps across Europe in the name of racial purification.

At the same time psychotic people are quite likely to be violent and unpredictably so. Untreated they eventually get in trouble with the law. Usually it is a minor offence, but sometimes it is a violent crime like murder. In Ontario there have been several high profile cases of murder by people with schizophrenia; Brian Smith in Ottawa, the subway pushing in Toronto, the Antidormi child in Hamilton. Treating such psychotic individuals became the subject of an election promise in the last provincial election. In New York state it only took one subway pushing to approve Kendra's Law, community treatment legislation, that forces some people to take their medication or be hospitalized. People argue such legislation infringes on an individual's civil rights, others that it wastes precious resources that could be spent on other community services and supports, like housing. It is the public response to senseless and violent crime by psychotic people that drives the enactment of such legislation. And ultimately the public's right to safety will override individual rights. Someone with tuberculosis for example cannot be discharged from a hospital until they no longer pose a threat to the public, no matter what their civil rights are.

Because people become psychotic without any awareness of the process, the issue becomes one of at what point do you assess and/or hospitalize people involuntarily. In Ontario legislators have always used the threshold of dangerousness itself. It is not a crime to be crazy, it is a crime to be dangerous, to threaten or harm people. Even then the law recognizes people may not be criminally responsible for their crime. They may be crazy and need treatment. You can logically predict that psychotic people are going to commit a lot of crime reaching a threshold of dangerousness and that is exactly what has happened in the last ten years as hospital beds have closed.

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